Saturday, July 4, 2009

Advanced equipment at airports, ports and crossing points: the coordination of Tunisian, Algerian Lippi with the World Health Organization to track avian and swine, plague

Saturday 4 July 2009 at 22:13:48 GMT Tunis

Started in the Tunisian health authorities and the Algerian, Libyan and Egyptian with the World Health Organization moves on many fronts to address the possibility of the spread of infection and transmission of bird flu or swine plague.

To date there are no cases of plague in Tunis, according to sources from the Ministry of Public Health, but said the casualties in Libya in the limited and narrow focus of a small adjacent to the Egyptian border, the Egyptian authorities fear the tourist season, in front of more than one million Egyptian workers in Libya In addition to the vast border between the two countries and more than 1150 km, while extending the border between Tunisia and Libya, 459 kilometers only.

Plague, or the so-called scientific «Alisina Taonip» (Yersiniapestis) is a bacterium that has emerged in previous decades, disappeared and was shown from time to time in certain spots have emerged in the nineties in India, which is infectious, but less serious epidemic of tuberculosis.Has contacted the Department of Public Health, confirmed to us by Dr. Mundhir Bedjaoui Kahie Director of the epidemiological surveillance and control of communicable diseases, the «Epidemiological Alisina» affecting the lymph nodes or the so-called in Tunisia (Alolcic) Balantfaj, the bacterium is moving in the blood, but only in (Alolcic) and can be addressed smooth, less serious than bacterial pneumonia contagious epidemic through sputum and breath .. In the second case Valty easier.

He assured that the siege of the Libyan authorities in connection with the center of the epidemic (which moved some of the infection on to Algeria, through the nomadic particular) said that the World Health Organization in connection with the follow-up is carefully coordinated with the States concerned.

Health system, accurate The treatment of this epidemic is possible with antibiotics and said that we are following the situation carefully, and appreciated the high proportion of the risk and made sure that small.Dr. Bedjaoui said that our health system is very strict and we carefully monitor any injury occurred in the form of the intervention would be a speedy and effective as we have adopted a system of surveillance based on the biological and medical and biological laboratories equipped with the latest techniques and technologies, and all suspected cases in which care is carried out the necessary analysis and then identify and address in the form of injury and make sure he said: «We're prepared for all eventualities and we have all the means and methods to account for the plague of HIV».He also said we are the follow-up and control the most serious disease of about twenty that have energy and a contagious epidemic, rapid proliferation and, therefore, «we have focused a general framework for finding and declaration of disease and the effectiveness of address» said «We have informed the doctors and we have warned for more vigilance and increase vigilance».He denied the existence of any cases of this disease in Tunisia, and there is coordination between the States concerned and the World Health Organization, and even those in tight spots in Libya or Algeria, the control possible.For the plague that threatened to crawl from the south and Almentsbp him impregnable walls healthy, but how prepared health management in Tunisia of the virus creeping from the north, known as swine flu virus scientific name (H1 N1)?

Visitors from the north

The Tunisian Ministry of Public Health sought approaches or ways to resist the virus, swine flu and the way he named the first Dr. Munther Bedjaoui Our actions to address the prevention of entry, since the virus was in some regions of the world such as Mexico and the United States and Canada ... And the Ministry of Health has tried to monitor the situation after the intensified surveillance in airports, ports and crossing points by focusing on the machines to monitor the heat after using the infrared ray and can monitor the cases infected by the temperature of the body, are also sometimes resort to the measurement of temperature by means of suspected cases regular and known and were monitored carefully to all the entrants officially announced the existence of three cases, is now in the process of follow-up and said there are 60 suspected cases under control, but can not confirm the injury.

Not the most dangerous of the winter influenza

The focus of the Ministry of Health in the central informer Charles Nicolle Hospital, Tunis-finding and analysis of cases and suspected cases in the form of an injury, it is isolated and treated, the official said, we have a sufficient stock of medicines to combat swine flu.The second phase or the second method, after that changed and how to address the Ministry of Health following the discovery of three people and injuries to entrants prepared all concerned to strictly, and said Our has been shown that it is not serious, not more dangerous than regular winter influenza (uncertainty)."Some viruses when they appear in the new strain is feared all seriousness, as is the case for the N5 H1 virus known as avian flu, but the proportion of N1H1 fatality (death) when little, so that cases that have emerged in Mexico and Canada was brought under control and there was no longer deals medicine.

WHO emergency

Here the question arises, since the swine flu virus was not serious, then why do all these warnings and alert the world, especially by the World Health Organization, which submitted to the sixth grade and as a global pandemic?Dr. Mundhir Bedjaoui answer by saying that there are some viruses that are not dangerous in the beginning with no Mujtha first, but later evolve from season to another and be able to adapt to it and become stronger, and the warnings of the World Health Organization is in this context, it is feared that the second wave of this virus and the fear that develops, especially during the coming winter, therefore, must prepare now to meet it."We will campaign to raise awareness and distribution of more than 100 thousand of this outstanding issue and said we are ready for a high enough stocks of medicines and reagents minutes.

Fear of the second waveIn the form of the virus in the second Mujth during the coming winter will do what the Ministry of Health?Ojabna ministry official said in the form of proliferation, we will concentrate on serious cases is expected to be the number of casualties in the coming winter than it is now, which could affect more on the elderly and people living with lung diseases, heart diseases and some chronic diseases, so doctors will be the focus as the level of risk ."We are ready with ambulances and equipment and we have all the capabilities and means to address, in the form of the existence of injuries, saying it will be isolated so as not to spread infection and possibly more private clinics will be the focus of the injured, but there is an important role as a citizen of the protection begins from home, by isolating the patient and the use of tissue paper and then throw in a special container and wash your hands for sure more than once a day with the adoption of preventive measures, which will be announced in the postings and campaigns rationalization.Our said that it was no cause for concern or panic, possible prevention and treatment is also available and effective and not a serious disease.

Is it war?In general, what can be said is that prevention remains the most important geographical location make Tunisia is located in an area between the threat of encroachment Khammash epidemic of avian and swine encroachment from the north and remains an open question to what we hear from time to time epidemics and sophisticated viruses before us on the question of global epidemics and medicine and industry laboratories problematic viruses and bacteria, is the new war? Epidemics and their dirty tactics?

[This is the second article, saying "twice as many as seasonal influenza".]

From a previous article out of Australia:Posted: 02 July 2009

Professor Robert Booy, an immunisation specialist at the Westmead Children's Hospital in Sydney, said the H1N1 flu was likely to kill twice as many children over the next 12 months as regular influenza.

In Belgium will end next month, by day six or seven people to death the Mexican flu and 15,000 people are daily infected with the virus. This prediction was virologists Marc Van Ranst Saturday for the Flemish public broadcaster VRT. He base itself on British figures.

At this moment, in Belgium 51 people infected with the Mexican flu. Van Ranst, professor in Leuven and flu expert from the Belgian government, thinks the number of new cases will soon rise because many people during their holidays abroad in contact with the virus.

He is soon impossible to anyone who gets infected, too, treatment with antiviral agents. Only patients who really need these medicines still used to get. The rest just uitzieken, as with an ordinary flu. In die each year some 1500 Belgians to ordinary flu, or four per day.

Wednesday, July 1, 2009

People in Argentina are starting to panic about the spread of swine flu, with at least nine more people dying from the virus overnight.

Just three weeks ago, swine flu was something that Argentines thought Mexicans and perhaps Americans had to worry about.

Officially 44 have now died from the virus, but unofficially, the tally may be as high as 150, giving Argentina a death rate higher than any other country.

3 days later, we have 10 more deaths:

4 de julio de 2009

This was stated by the Minister of Health, Juan Manzur, who stressed that "instructions" given to him by President Cristina Fernandez is put our best men and women to respond to this situation. "

Health Minister, Juan Manzur, said today that there are 55 patients confirmed to have died in the entire country by the Influenza A virus (H1N1).

"We received the (Institute) Malbrán laboratory-confirmed patients who have suffered from the presence of H1N1 and is today the official figure of 55 patients confirmed to have died" because of the virus, said the official.

In dialogue with the All News Channel (TN), Manzur stressed that "education" that gave the president Cristina Fernandez de Kirchner is put our best men and women to respond to this situation. "

Yesterday, at a press conference the Minister of Health of Buenos Aires, Jorge Lemus, accompanied by the chief of staff of the portfolio, Néstor Pérez Baliño, and members of the Committee of Experts, said that "individual conscience" and "responsibility" is the best measure to prevent the spread of the virus.

Consulted on the main actions to be taken on public transport such as subways or groups, experts ruled out the use of chinstrap, except for sick people, and recommended the use of lavandin to sanitize handles, seats and other surfaces contactRegarding the figures that were released from Nation on the number of people infected with Influenza A, said: "It is impossible to know with accuracy and minimizing the need to know this information because it said" prevention "is the same as for a common flu.In this regard, he assured that "no longer take the figures for all people who have symptoms, but the fatal cases and internees" to assess the progress of the disease, according to which they decide to take action.

Consulted experts about the need for measures to prevent further said that "follows the daily dynamics of the disease, which this week went to the common flu, and that next week we'll see how it continues."

The World Health Organization and developing nations have called for measures to ensure poorer countries have access to a future A(H1N1) vaccine.

According to Margaret Chan, World Health Organisation Director General, a vaccine for swine flu, the first pandemic of the 21st century, may be available as early as August. That is good news - at least for peole in industrial countries.

But during a WHO swine flu summit, which wrapped up on Friday in Cancun, Mexico, Chan said that laboratories with capacity to produce the vaccine are mostly located in Europe. Experts say this could have dire consequences for poor countries, especially those in the southern hemisphere.

The tourists have stayed away, but the WHO meeting has brought some trade to Cancun.

90% of projected stocks committed to rich countries

Jon Kim Andrus, an expert from the Pan American Health Organization (PAHO), said that 90 percent of the vaccine is already commited to high income countries, where some 893 million people live, and 10 percent to countries like China and Russia, which can produce some of the vaccines themselves.

"If they began marketing the vaccine right now, developing countries would not get any," Andrus said at the Cancun summit.

Spain's health minister, Trinidad Jimenez, called for the WHO, together with the European Union, to reserve a portion of vaccine stock to be purchased for developing countries.

"We cannot allow a massive reservation of stocks for purchase by a few countries," said Jimenez. Spain will not be able to build a laboratory capable of producing A(H1N1) vaccines until 2012.

The WHO and PAHO are negotiating with vaccine producers to secure donations or sales at lower prices for developing countries. Richer nations are being asked to share some of their vaccine stocks.

The WHO director general Chan said two companies had agreed to manufacture 250 million doses to be sent to developing countries, but she also acknowledged that the amount "is obviously not enough."

Chan said that while the first vaccines may be ready in August, recommendations for use may take awhile longer. She urged rich countries not to hoarde future vaccine stocks.

Chinese want to go it alone

China wants to be self-sufficient in vaccine production, Chinese Health Minister Zhu Chen said on the summit sidelines on Friday, and plans to have a vaccine available by September.

The Chinese minister said that some public companies in China are in the initial manufacturing process of a vaccine and that a preliminary version is likely to be ready by the end of this month.

The virus is currently being treated with influenza drug Tamiflu. However cases of infection resistant to the drug have been reported in Hong Kong, Denmark and Japan.

Great Britain the worst affected in Europe

Britain has warned it could face more than 100,000 cases of swine flu a day by the end of August, if the current infection rate is maintained. With nearly 7,500 cases of swine flu, the country has already been hit hardest in Europe.

British health officials say they have abandoned attempts to stop the flu spreading, instead focusing on those who are most susceptible, such as the obese or those with asthma or other respiratory conditions.

Three people have died in Britain so far from the virus.

Mexican Health Minister Jose Angel Cordova called for "solidarity so that money is not the only factor in producer decisions about the distribution of the vaccine."

Mexico was the epicenter of the pandemic and remains the second worst-affected country after the United States.

To date, at least 337 people have died around the world from swine flu, which has infected 80,000 people in 121 countries.

Despite the messages of the Ministry of Health to reassure the citizens of the weak and the swine flu virus is confined only to foreigners and people from overseas and the country living the time of the winter now, the virus suddenly decided to move to the injury of the Egyptians and has many qualities, which only affects the outside was now inside the Egyptians as well.

The Ministry of Health increased the number of cases of infected swine flu in Egypt to 74, including the case of more than 15 cases of the Egyptian Minister of Health and justified as cases associated with positive infectious cases of infected coming from abroad to move to that second injury to a transition between the Egyptians.

The first cases of the Egyptians, which was not linked with any epidemiological situation of the working man Egypt Pyramid Hotel Sofitel, which resulted in the wounding of her colleague, the hotel to record the second Egyptian to HIV infection, but the result of association with people affected by the epidemic.

In return, the Ministry of Health has confirmed the vulnerability of the virus, a sign in the official report on the epidemic situation in Egypt showed that 57.7% of cases less than 20 years and about 15% of the total cases, greater than the age of 45 years.

It also stressed that most cases of coming to Egypt of the country affected, indicating that there is still so far the virus does not cause a severe disease or serious complications, and no cases of mortality from the disease of avian (H1N A) in the republic.

One of the infected cases, which recorded 71 No. Egyptian nationality to a student at the age of 8 years of the Eastern Province, which is linked to infectious cases, a positive prior, which was seized a hospital in Cairo have been given appropriate treatment and in stable condition.

This came after the wounding of four East aged (3, 10, 13.14), and cases linked to epidemiological situation is also positive for the girl, the Egyptian - American citizenship to come along with her family from America to a Cairo on June 2.

In addition to the injury of young Egyptians from Ms. Umra and who registered the first cases coming from Saudi Arabia because of Umrah, the situation was for the 66 Egyptian woman, aged 48 years from the Alexandria governorate arriving from Saudi Arabia (after performing Umra) on June 25 was booked and given hospital treatment appropriate and stable condition.

Returned from San Francisco with mother and daughter (confirmed patient) on June 11

Admitted to United Christian Hospital (UCH) on June 12

Imported

Singapore Airlines (flight no SQ1) Arrived on June 11

Daughter (confirmed patient), mother, two sisters , a brother

The above data, from a Hong Kong DOH report describing pandemic H1N1 confirmed cases, is the only entry that matches reports on the 16 year old who was intercepted at the airport on June 11 and was subsequently found to be infected with Tamiflu resistant H1N1. The patient's flight had originated in San Francisco, and Singapore Airlines flight SQ1 is a nonstop flight from San Francisco to Hong Kong, providing additional evidence for Tamiflu resistant H1N1 in northern California.

The above description indicates the confirmed patient was the daughter in the traveling family described above, The cases is also described as asymptomatic, in contrast to media reports which indicated where was identified because of a fever. The cause of the discrepancy remains unclear, although the above report lists the age of the female patient as 36 instead of 16 and admission into United Christian Hospital instead of Queen Mary Hospital although transfer from one hospital to another could explain that discrepancy.

In any event, the above description is the only patient listed who flew into Hong Kong from San Francisco on June 11, and likely represents the case who had mild symptoms or was asymptomatic on arrival. Since the patient was not taking Tamiflu, the resistance would represent a fit pandemic H1N1 which is likely circulating in the United States.

Currently, efforts in the United States are directed toward severe cases and would likely miss either mild or asymptomatic individuals, allowing for silent spread of Tamiflu resistant pandemic H1N1.

The other two reported cases with H274Y (Demark and Japan) were from patients who were on a prophylactic dose. Although agencies have focused on a spontaneous mutation selected by the Tamiflu treatment, the reports do not exclude a mixture, with the H274Y on a minor population. A mixture would also raise concerns of silent spread of H274Y. The presence of h274Y in a treated patient may also be present in India, where a patient is asymptomatic, but shedding pandemic H1n1 in spite of a full course of Tamiflu treatment. The emergence of H274Y in treatment patients may simply reflect selection of this minor population. However, the presence of h274y in a minor population could lead to a jump onto another variant of pandemic H1H1, as was seen in seasonal H1N1. The fixing of H274Y in seasonal flu was preceded by H274Y in a number of clades and sub-clades, signaling multiple dependent introductions into hosts not taking Tamiflu.

The fixing of H274Y in seasonal flu has led to predictions that pandemic H1N1 with H274Y would emerge due to recombination between seasonal and pandemic H1N1. Others expected such dual infections to lead to acquisition of H274Y by reassortment, but none of the examples describe to date have involved reassortment and acquisition of human N1.

The reports of three examples of H274Y this week supports acquisition via recombination, and more such examples are expected in the near term, as more labs focus on H274Y in pandemic H1N1.

LUDHIANA: With the detection of H1N1 virus in a Ludhiana based family in Amritsar, the health department has swung into action with its

integrated surveillance team now sending emails to all the civil surgeons across the state for tracing 50 more passengers, who came in contact with the infected child, to prevent any further spread of the infection.

While giving information, nodal officer of Integrated Disease Surveillance Programme Deepak Bhatia said, “As swine flu spreads through human to human contact, it was mandatory for the health department to check all the people who came in contact with the infected child.”

Bhatia informed that the family belongs to Randhir Singh Nagar in Ludhiana. When 11-year-old Karan Preet Singh’s throat swab test turned positive, the health department acted swiftly and isolated the parents of the child. He said the department was planning to give chemoprophylaxis treatment to the sister of the 11-year-old child. He said as a safety measure, the health department had given chemoprophylaxis treatment to all those who had come in contact with the child.

Integrated Disease Surveillance Programme has sent an email on Friday to all the civil surgeons of the state to trace all 50 co-passengers who had come in contact with the H1N1 positive child.

The nodal officer, while giving information said as the flight had landed in Amritsar and it was a direct flight from Canada to Punjab, so most of the co-passengers were expected to be from the state itself.

On being asked about any co-passengers from the city, he said there was only one from the city, while rests were from Hoshiarpur, Ferozepur, Bathinda and other districts of the state. He said the department was on it toes to trace all the co-passengers and would start giving them chemoprophylaxis treatment.

MARIN COUNTY, Calif. -- Approximately 800 minimum-security inmates were under quarantine at San Quentin State Prison Thursday due to four probable cases of H1N1 influenza, California Prison Health Care Services announced.

Prison officials said while there are four probable cases, 30 inmates have shown potential symptoms of the virus and have been tested.

Health officials recommended that the California Department of Corrections and Rehabilitation quarantine the areas where the infected inmates are housed. That area includes four dormitory blocks, affecting approximately 800 inmates.

.With a large number of tourists from many countries in the world in the context of pandemic influenza A/H1N1 is more wide spread and complex place, prevention in the province requires the prepare carefully and always in the mind ready.

Care, treatment patients at the Faculty of Islamic emergency, Hospital of Bai Chay.

The Hospital of Bai Chay, upon the direction of the provincial People's Committee, Department of Health, the Hospital has established the Steering Committee with preventive component is the volume of scientific production, children, ... anti-bacterial, building planning, prevention of disease; 1 assigned staff regularly monitor the information on flu A/H1N1 through agencies and through the media of the to timely advise the BCD units of measures for active and timely response to, the establishment of the revenue available to the emergency treatment and support to other units in case necessary.

Up to this time, when people detect influenza A/H1N1 infection in the country are increasing trend, then the preparation preparation available for prevention of disease, to receive the patient's hospital Again as in the province requires all levels than ever, as we have many provinces to the border with guests of immigration significantly.

Under guidance of the Ministry of Health, if the patients try to influenza A/H1N1 treatment in place, any severe cases new to the transit, to be monitoring closely and limit the spread of migration for contract. So that the treatment in line always ready to medicines, materials, chemicals, machines breathing for the reception, treatment of patients.Most of the districts in the province equipped 1-3 in breathing, such as East 3 million machines, Hospital area in Bai Chay 4, Hospital of Mong Cai 3 machines etc. .. Besides the emergency mobile units of treatment are available to support other units as needed.

. With steering control, close monitoring, timely detect cases and suspected patients in the border gate, the health sector in the province is only strengthening surveillance in the community, so task of units for the province as more heavily. Besides the review of materials, chemical medicines, disease transmission, since that time additional suggestions for the prevention of disease, the unit also actively collaborated with the sector functions of local positive disseminating awareness of the people of flu, people to actively prevent.

At the Medical Center for the provincial reserve Tamiflu 4000 Vienna, 4 tons CloraminB.The medical center and general hospital districts, each unit from Vienna Tamiflu 200-500, 150-300kg Cloramin B, antibiotics, disease transmission, equipped to the page.Each health center is 2-6 in the spraying of chemicals to target the same type, the micro-organism environment etc. ..

Ministry of Health, Department of health in, give the units, nearly 7,000 local propaganda leaflets what to know about pandemic influenza A/H1N1 and influenza prevention information for visitors entering.The provincial health district organized training knowledge monitoring flu A/H1N1 and influenza infected patients to staff of health units and health commune ... This monitoring influenza A/H1N1 epidemic in particular, other diseases in general is done quite well.

Exercise flu A/H5N1 in Cam Binh ward (Cam Pha). Image: TN

Not only the health sector, provinces, departments, unions in the province to also active in the prevention of pandemic influenza A/H1N1. PPC continuously out of office, documents, organizing meetings to speed up, prompted the local branches actively work to prevent outbreaks. Many localities have made the quite flexible in mobilizing the people to to monitor, detect and prevent the disease for yourself and family.

As of Dong Trieu district People's Committee for expenditure in local advocacy leaflets on symptoms, and prevention of influenza A/H1N1 in every household in the district, Hospital Dong Trieu district expense by using Unit purchase gloves, clothing protection to actively prevent cross infection disease in hospitals and spread to the enforcement of public duties.

... Mong Cai City timely review of medicines, chemicals, revise the temporary isolation in the border gate to isolation, counseling cases have visitors entering the symptoms of suspected right from the beginning and appear in a countries in the world ...

The propaganda of this pandemic have been posted on the media in the provincial, district and central loudspeaker system in communes, wards, villages, hamlet, unit, business, etc. ..

According to the situation, Quang Ninh, a day more than 3000 visitors entering, not including the case of illegal immigration through border pathway to work, trade ...; occasion summer many tourists and students from other countries to tourism ... the risk of appearing flu A/H1N1 large.

While the province has A/H5n1 flu, avian influenza circulating and appear back at the Lien Hoa commune (Hung Yen), once patients have died because of influenza A/H5N1 infection .. .

Therefore, if not better prevention, monitoring of disease, especially for flu A/H1N1 viruses of this type interact with each other, the nature of epidemics became complex and dangerous. Therefore all levels, sectors and localities must always interested in the work available to the project site 3: the on-site, local materials, on-site processing; simultaneously require participation in many of the forces of the community to hand them the prevention of pandemic influenza A/H1N1 in the province.

New Delhi, July 4 : A Thai national was found suffering from swine flu, taking the total number of influenza A (H1N1) cases in India to 129, said an official statement Saturday.

“The only new case reported Saturday was of a 23-year-old Thai national who travelled from Bangkok to Mumbai by Thai Airways flight TG 317 that reached Mumbai June 28 and proceeded further to Kandla port (in Gujarat) to board a ship on which he is a crew member,” it said.

“He was detected at the screening at Kandla port and isolated at the Kandla Port Trust Hospital July 1. Four other crew members in close contact with this case have also been placed under quarantine. They have been put on chemoprophylaxis.”

The statement said, "871 persons have been tested so far, of which 129 are positive for Influenza A H1N1. Of 129 positive cases, 90 have been discharged."

According to the World Health Organisation (WHO), about 89,921 confirmed cases of influenza A H1N1 infection have been reported from 125 countries till July 3. There have been 382 deaths worldwide, most of them in Mexico and the US.

- The 4 / 7, Ministry of Health notified Vietnam have 7 of influenza A/H1N1 infection, the total influenza A/H1N1 patients to 215 people in 20 provinces.

.In 7 patients a new, 5 people registered to stay in the South and 2 patients in the North.

Thus, both the 2 patients has been detected through the afternoon (3 / 7), the North has 21 of the influenza A/H1N1 infection (Hanoi 19 ca).

The case of the Vietnam with airway on flights: VN782 on 26/6/2009, SQ178 on 30/6/2009, VN782 and TG686 on 01/7/2009

Patients infected with influenza are treated in the isolation, health stable (Photo: CQ)

Vietnam is a local leader of the number of infected and suspected infected with influenza A/H1N1.

.Each day, Ho Chi Minh City Health Department must isolation of dozens of people infected and more recognition of the new infection.Typically 1 / 7, have to get 35 new cases and 3 / 7 to 25 have affected people.

A/H1N1 flu in Vietnam are complex variables, number of patients increased rapidly.

Nguyen Huy Nga, Director Department of Department of Health and Environment (Ministry of Health) said: "There is a significant concern as we can not know the exact influenza A/H1N1 will change how.Therefore, self-awareness and awareness of the people against the kinds of "vaccine" most effective ".

Dr. Nguyen Van Kinh, Director of the Institute for infectious diseases and Tropical countries that "generally A/H1N1 flu patients start out 2-3 days after fever and after 5 people will be really fever.Presently, we can say-minded control of the Ministry of Health to promote the good, the treatment of influenza A/H1N1 does not do problems ".

China is planning to amend its contingency plan of influenza pandemics to tackle the challenges of the possible out-break of the A/H1N1 flu epidemic across the country, according to Chen Zhu, the minister of China's Ministry of Health.

Chen made his remarks Thursday at a two-day summit of World Health Organization (WHO) in Cancun, a beach resort town in the Mexican state of Quintana Roo.

At the summit, Chen introduced measures adopted by the Chinese government to fight against the flu and the epidemic situations in the country to the WHO Director-General Margaret Chen and health ministers from around the globe.

China will step up efforts on the surveillance work and further develop the surveillance network covering more than 50 percent of prefectural-level cities nationwide, said the health minister.

Laboratories and sentinel hospitals will also be established around prefectural-level cities as well as key counties to ensure the flu cases, viruses, and underlying medical conditions are under control.

Chen also expressed China's determination on sharing experiences with the globe and working together with the world to develop the strategies and vaccines against the virus.

While addressing a side session on Friday, Chen said the international reporting system could be improved beyond encouraging and facilitating member states to strengthen solidarity and cooperation based on mutual respect.

He also called for the restructuring of pandemic reporting system to make it more global and more up to date, and asked the WHO to review the scientific definition of flu and develop strategies to prevent its mutation.

Earlier this evening I fretted about numbers and projections that seem impossible. Apparently I'm on the same page as the editor of Arab News: Editorial: Spread of swine flu. Excerpt:

Preparations do not mean that millions will not be infected, rather than millions will not die. At present, in addition to the 300 who have died worldwide since the outbreak started, some 70,000 have been infected in over 100 countries.

But this is set to rocket. The UK, for example, the worst hit country in Europe, expects a 100,000 new cases a day within just eight week’s time. That is a staggering prediction and difficult to believe.

If the outbreak were to continue at that rate, it would mean 24 million people infected before the end of April. Moreover, at the present rate of three British deaths to 7,447 confirmed cases, that translates to almost 10,000 deaths by the same time.

But before dismissing this out of hand as mathematical modeling gone crazy, no country can afford to let its guard down.

That is especially so in Saudi Arabia, where the Haj season always results in the spread of new viruses. It is just months away. As of yesterday there were 106 confirmed cases and the number is increasing as elsewhere.

For years, Flublogia has worried about being physically prepared for a pandemic. (Today on CBC Radio's The Current, Dr. Peter Sandman was very eloquent about this.)

But psychological preparation may be even more important: Getting it into our thick heads that people will fall ill in great numbers, that institutions like hospitals and corporations will shut down, even if the mortality is not great.

We will not be able to leave the theater after two hours of delicious, vicarious fear. We won't be able to change the channel. It will not be happening far away, but on our block.

For people in the developing world, long accustomed to violence, malaria, dengue, HIV, and infant mortality, a pandemic may be easier to take than it will be for us in the industrial world. We have been very well protected for half a century. Almost four years ago, we saw how quickly things could fall apart when Katrina hit New Orleans, but we did our best to forget it.

Stress reveals character. I hope that the stress of the next six months reveals character worth respecting in those of us who have enjoyed the greatest benefits of the last 60 years.

Britain warned it could face more than 100,000 daily cases of swine flu and the United States called a meeting of top officials as governments grappled on Friday with a resurgent swine flu pandemic.

The warning from British Health Secretary Andy Burnham came as the Japanese health ministry said doctors had detected the second case worldwide of a patient resistant to the anti-viral Tamiflu, widely used to treat the illness.

Burnham told parliament that 100,000 cases a day could occur in Britain by the end of August if the current infection rate is maintained. The country already has Europe's highest number of reported cases.

Health officials say they are abandoning trying to stop the flu spreading, instead focusing on people who are most susceptible, such as the obese or those with asthma or breathing problems.

"Cases are doubling every week, and on this trend we could see over 100,000 cases a day by the end of August, but I stress this is only a projection," Burnham told the House of Commons on Thursday.

Britain now had nearly 7,500 cases of swine flu, he added, with hundreds of new cases being confirmed every day. Three people have died in Britain so far from the virus.

The latest numbers from the World Health Organisation, released on Wednesday, showed 77,201 reported swine flu cases, with 332 deaths.

In Washington, the White House said it would hold a high-level meeting next week bringing together top government officials to prepare for the possibility of a more severe outbreak of A(H1N1) influenza.

Health and Human Services Secretary Kathleen Sebelius, Homeland Security Secretary Janet Napolitano and Education Secretary Arne Duncan will take part in the meeting at the National Institutes of Health next Thursday.

The meeting was called after the US Centers for Disease Control and Prevention (CDC) estimated that at least one million people in the United States have had swine flu, basing the projection partly on computer models.

There have been roughly 28,000 confirmed cases of swine flu in the United States and 127 people are reported to have died, the CDC said.

In Japan, the health ministry said doctors in Osaka prefecture had identified a woman who was resistant to Tamiflu -- the second such case in a week, after one found in Denmark.

The Japanese woman had since been treated with another medication, Relenza, and was recovering, Kyodo news agency reported Thursday, citing the health ministry.

A spokeswoman for Swiss pharmaceuticals giant Roche, which makes Tamiflu, called the case "absolutely normal" and added that "0.4 percent of adults develop resistance" to Tamiflu.

In China, furious relatives of a woman who died while being treated for suspected swine flu stoned an ambulance in a rampage at a hospital in the eastern city of Hangzhou, state news agency Xinhua reported.

Initial reports stoked fears she might be the first person in China to die from swine flu, but police said on Friday that an autopsy had shown she died of an electric shock.

Xinhua reported that the woman had shown no symptoms of swine flu at the time of death, barring an occasional cough.

Elsewhere in Asia, Brunei reported its first swine flu death.

In Latin America, a nine-year-old boy became the first person to die in El Salvador from the virus, the health ministry said Thursday.

The Americas have been the hardest hit by the disease, with the United States, Mexico, Canada and Argentina suffering the vast majority of the world's fatalities.

El Salvador, close to the initial source of the current pandemic in Mexico, has seen 277 confirmed cases of A(H1N1) and a further 178 patients are being watched.

On Thursday the WHO vowed that poor countries in the Americas would receive enough anti-virals to combat the swine flu outbreak.

At a summit in Cancun, Mexico, WHO director-general Margaret Chan said Roche had promised to supply 5.6 million Tamiflu treatments for distribution to developing countries.

The head of the Pan American Health Organization, Mirta Roses, said a US donation of 425,000 Tamiflu courses would cover immediate needs.

"The region is pretty well covered with anti-virals, with equipment for diagnosis," Roses said.

[This document will also be posted in the right side-bar under "Preparations". Please click on the title for the full document to open.]

June 4, 2009Excerpts:

SummaryA flu pandemic is a worldwide epidemic of an influenza virus. As such, the United States’response to a flu pandemic would have both international and domestic components. Additionally, the domestic response effort would include contributions from every governmental level (local, state, tribal, and federal), non-governmental organizations, and the private sector. This report will focus largely on the role of the Department of Defense (DOD) in supporting the nation’s domestic response effort, although it will also touch on DOD’s international role.

The Department of State would lead the federal government’s international response efforts, while the Department of Homeland Security and the Department of Health and Human Services would lead the federal government’s domestic response. The Department of Defense would likely be called upon to support both the international and domestic efforts. An analysis of the tasks assigned by the National Strategy for Pandemic Influenza Implementation Plan indicates that DOD’s role during a flu pandemic would center on the following objectives: assisting in diseasesurveillance; assisting partner nations, particularly through military-to-military assistance; protecting and treating US forces and dependents; and providing support to civil authorities in the United States.

With respect to providing support to civil authorities in the United States, the types of defense support which would likely be in greatest demand during a flu pandemic include: providing disease surveillance and laboratory diagnostics; transporting response teams, vaccines, medical equipment, supplies, diagnostic devices, pharmaceuticals and blood products; treating patients; evacuating the ill and injured; processing and tracking patients; providing base and installation support to federal, state, local, and tribal agencies; controlling movement into and out of areas, or across borders, with affected populations; supporting law enforcement; supporting quarantine enforcement; restoring damaged public utilities; and providing mortuary services. Note, however, that DOD’s ability to support these requests would be limited by its national defense and force protection responsibilities. The two principal ways in which defense support could be provided to civil authorities are by way of an “immediate response,” or in response to a formal “request for assistance” (RFA). Additionally, in extreme circumstances the federal government may expedite or suspend the RFA process and initiate a “proactive federal response.”

National Guard personnel would almost certainly be involved in domestic response efforts as members of their state militia under the control of their governor. Current DOD plans do not anticipate federal mobilization of the National Guard or Reserves to respond to a flu pandemic.However, these plans could be modified if circumstances warranted it (for example, if the severity of the pandemic significantly exceeded DOD’s planning assumptions). In the event such a federal mobilization is contemplated, an important consideration would be the impact it would have on any response efforts that were already occurring at the state and local levels. For example, the activation of Reserve and National Guard medical personnel may pull them out of local hospitals where they are already engaged in the response effort, thereby undermining state and local response efforts.

-snip-Defense Support of Civil AuthoritiesDuring a serious flu pandemic, there is a strong possibility that local, state, and federal responders will request assistance from the Department of Defense. DoD has a broad range of capabilities that could be useful to civil authorities in emergency situations, including transportation assets, medical personnel and supplies, security forces, and communications equipment The NRF and the Implementation Plan refer to this type of assistance as Defense Support of Civil Authorities (DSCA), while DoD often refers to it as Civil Support (CS) or Military Assistance to Civil Authorities (MACA).27 This report will follow the NRF terminology unless otherwise specified.-snip-

Proactive Federal ResponseThe NRF provides for a proactive federal response to a “catastrophic incident.”39 If a flu pandemic were severe enough – that is, if it caused extraordinary levels of death or illness which had severe societal impacts -- it could qualify as a catastrophic incident. A proactive response would allow for the prepositioning of federal assets in anticipation of state, local, or tribal requests for assistance; it would also permit the federal government40 to take charge of coordinating the response if the affected state, local, or tribal governments were unable to do so.41

39“A catastrophic incident, as defined by the NRF, is any natural or manmade incident, including terrorism, that results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, and/or government functions. A catastrophic incident could result in sustained nationwide impacts over a prolonged period of time; almost immediately exceeds resources normally available to State, tribal, local, and private-sector authorities in the impacted area; and significantly interrupts governmental operations and emergency services to such an extent that national security could be threatened.” Department of Homeland Security, National Response Framework – Catastrophic Incident Annex, November 2008, p. CAT-1,http://www.fema.gov/pdf/emergency/nrf/nrf_CatastrophicIncidentAnnex.pdf .

Activating the National Guard for Pandemic Flu ResponseNational Guard personnel would almost certainly be involved in state efforts to respond to a flu pandemic as members of their state militia under the control of their governor. Current DOD plans do not anticipate calling the National Guard into federal service to respond to a flu pandemic.51 However, as with the case of the federal reserves, these plans could be modified if circumstances warranted it. DOD policy guidelines currently specify that, if Reserve Componentmedical personnel are required to respond to a flu pandemic, the military services are to “use [federal] Reserve forces first, leaving National Guard forces to be available to meet their statebased missions.”52

-snip-“Title 32” StatusAnother way in which National Guard personnel can be activated and remain under the control of their governor is under the authority of 32 U.S.C. 502(f). This provision of federal law provides that “a member of the National Guard may...without his consent, but with the pay and allowances provided by law...be ordered to perform training or other duty in addition to [inactive duty for training or annual training].” The advantage of using this authority is that the National Guardpersonnel called will receive federal pay and benefits and are entitled to certain legal protections55 as though they were in federal service, but they remain under the control of their governor and are therefore not subject to the restrictions of the Posse Comitatus Act. This is the provision of law which was used to provide federal pay and benefits to the National Guard personnel who provided security at many of the nation’s airports in the aftermath of the terrorist attacks of September 11, 2001. It has also been used to respond to major disasters such as Hurricane Katrina in 2005.-snip-

An Osaka health official found a genetic mutation of swine flu that is resistant to Tamiflu on June 18 — nearly two weeks before the "first" finding was reported in Denmark — but failed to disclose it, the health ministry said Thursday.

The mutation, found in a woman in her 40s in Toyonaka who caught the H1N1 influenza A virus in May, is the first reported case of Tamiflu-resistant swine flu in Japan.

The World Health Organization declared the new flu a pandemic on June 11.

The case "is considered to pose no public health threat, given no infections have been confirmed around her," an official of the Health, Labor and Welfare Ministry said.

Nationwide, swine flu cases have topped 1,500, surfacing in 44 prefectures, but none has been fatal, the ministry said.

At an unscheduled press conference called around midnight Wednesday, Tetsuro Noda, chief of health issues related to infectious diseases at the Osaka Prefectural Institute of Public Health, was inundated with questions about why he failed to promptly report the discovery.

"The virus was dead in the patient and we judged it unnecessary to report it swiftly," Noda said. "In terms of public health, I didn't think it was a serious case and I feel sorry for the delay in the disclosure."

Osaka Prefecture said the woman carrying the Tamiflu-resistant strain recovered after being treated with Relenza, another antiviral drug.

The prefecture confirmed the genetic mutation on June 18 but did not report it to the health ministry until Wednesday, even though no other cases of Tamiflu-resistance had been reported worldwide. It was told to tell the public the next day

Friday, July 3, 2009

he information contained in this situation report uses the most accurate currently available data. Given the rapidly changing nature of the incident, recipients should be aware of the potential for later confirmation or clarification.

SEOUL, July 3 (Yonhap) -- Fifteen more people in South Korea were found to have been infected with the new H1N1 flu on Friday, raising the nation's total number of reported cases to over 250, health officials said.

Among the fifteen were a ten-year old boy in North Jeolla Province who had traveled to Australia late last month and a 27-year old Philippine woman residing here who had recently traveled to her homeland, according to the Ministry of Health and Welfare. A total of 253 cases have been confirmed so far

03.07.09 22:47A European health agency said on Friday that 641 new A/H1N1 flu cases were reported in European countries within the last 24 hours, Xinhua reported.

Of the new cases, 518 were confirmed in Britain, 20 in Spain, 7 in France and Switzerland, 35 in Germany, 25 in Cyprus, six in Denmark, five each in Portugal and Romania, three in Slovenia, two each in Sweden, Luxembourg and Ireland, and one each in Austria, Portugal, the Netherlands and Poland, the European Center for Disease Prevention and Control (ECDC) said in its daily situation report.

The total number of confirmed cases of the A/H1N1 flu virus in the EU (European Union) and EFTA (European Free Trade Association) countries rose to 10,094, with 776 cases in Spain and 7,447 in Britain, 318 in France and 505 in Germany, the ECDC said.

The ECDC publishes a daily situation report about A/H1N1 flu cases in the EU and EFTA countries based on official information from these countries.

Rabies epidemic declared in north after 4 deaths--------------------------------------------------------------Northern Lai Chau Province announced a rabies epidemic after 4 peopledied of of the disease and at least 500 people were been bitten byrabid dogs in the last 2 months.

"The 500 cases only account for the number of patients who got arabies vaccine at the province's Preventive Healthcare Centre afterbeing bitten," said Do Van Giang, deputy director of Lai ChauProvince's Health Department, adding that the actual number ofinfected people could be much higher.

Due to the high demand for dog meat, many local people transporteddogs from Phu Tho and Vinh Phuc provinces. These dogs then infectedthe local dogs, leading to the rabies outbreak, said Nguyen CongHuan, director of the province's Health Department.

"More people will die of rabies because they do not get the vaccine," he said.

The cost for the vaccine is high--- nearly VND1million (USD 56) for acourse 5 injections--- and 40 per cent of people in the province havean average monthly income of VND200 000 (USD 11), according to Giang.

"My pregnant daughter was killed by a rabid dog because she couldn'tget the vaccine in time," said a 64-year-old [resident of] Lai ChauTown, who recovered from [treatment for a bite from an animal thatmost likely had rabies] after several days of treatment in theprovince's hospital.

"Authorities should support patients like us and get us freetreatment. If not, we will not be able to afford the vaccine," said Thanh.

The province recently decreed that the poor would get free rabiesvaccines and others would get 50 per cent of the vaccine costsubsidised, said Huan.

Some local ethnic minorities lack information about the disease andchoose to treat it with herbal remedies instead of getting the vaccine.

"Many people rush around looking for herbal medicine after beingbitten by dogs. However, this is useless and causes more harm becausethere is no scientific basis for this treatment," said Bui TienThanh, a doctor at the province's General Hospital.

Local health officers have handed out leaflets about rabies andtreatment to educate people about the disease and have asked anyonewho has been bitten by dogs to go to the Preventive Healthcare Centrefor treatment, according to Nguyen Van Ngoc, deputy director of thePreventive Healthcare Centre.

"In addition, relevant authorities have increased the management ofdog transports from other provinces, and are more closely monitoringthe province's current canines," said Huan.

So far, the province's Veterinary Department has vaccinated 4 dogsand cats in the province.

"It has been decades since the last rabies epidemic and the provinceis trying to stop the spread of the disease as quickly as possible",said Giang.

The above newswire mentions about the transportation of dogs from PhuTho and Vinh Phuc provinces to Lai Chau province caused theimportation of rabies outbreak in the province. More information fromreliable source on the recent condition of rabies infection in PhuTho and Vinh Phuc provinces would be highly appreciated.

ProMED-mail virology moderator Mod.CP had the following observation:"Rabies in Viet Nam continues to be a problem partly on account oflack of regulation of the trade of dog breeding and provision ofdog-meat for human consumption. Comprehensive vaccination of canineswould both protect human health and have long term economic benefits."

EpidemiologySource of the outbreak(s) or origin of infection: under investigation [seecomment].

Epidemiological comments: A 3 km radius zone around the outbreak as well asa 10 km radius surveillance zone beyond the previous one have been established.

In the zone around the outbreak, all pig farms were inspected and noanimals with clinical signs were found. Only movements to theslaughterhouse are authorized after an official clinical inspection hasbeen carried out.

In the surveillance zone, pig farms are being visited in order to conductclinical inspections and surveys with the owners. To date, no new healthinformation has been reported. Movements of pigs to any destination areauthorized after an official clinical inspection has been carried out.

A total of 4 farms with an epidemiological link were also identified; theywere visited by the same veterinarian who had visited the affected farmduring the past 30 days. These farms were inspected and no new healthinformation was reported. No more sick animals have been observed in theoutbreak since 24 Jun 2009. On 25 Jun 2009, samples (nasal swabs) weretaken in 50 pigs from different categories (all less than 150 days old);they were negative for the RT-PCR test.

Animals were sent to the slaughterhouse after the results of the clinicalinspection and the RT-PCR were negative; no new health information wasreported after the ante- and post-mortem inspection.

[The statement addressing "zoonotic impact" in the above follow-up reportis similar to the statement included in the previous immediate notificationof 25 Jun 2009. This means that there is as yet no laboratory confirmationof the suspicion that the virus was introduced by humans, which was raisedin the immediate notification, saying "Between 7 and 9 June 2009, 2 workersof the farm showed flu signs, but they did not consult a doctor nor madediagnostic tests."

In view of the importance of clarifying the source of infection, it is ofutmost importance to test the 2 said workers and establish their diseasehistory. Until such data are available, the possibility that the source ofinfection could have been different, including pigs, cannot be ruled out.

The same applies to the Canadian (Alberta) pig outbreak of May 2009;ProMED-mail's request for information, dated 15 Jun 2009, has not beenresponded to as yet. It addressed the test results of the person who wasinitially suspected to be the introducer of the virus to the pig farm.Similarly, the later claim that human involvement in the Alberta event was-- eventually -- not confirmed (see 20090615.2215), lacked laboratory-basedevidence.

Concluding, 1st hand information and test results from the public healthauthorities or from the laboratories involved in the investigations ofpossible human involvement in 2009 H1N1 swine-influenza outbreaks on pigfarms in Argentina and Canada are needed in order to clarify the ratherblurred scenery. - Mod.AS]

CAIRO, July 3 (KUNA) -- One more person was diagnosed with swine flu virus in Egypt, and by that the number of victims reaches 72, Egyptian Ministry of Health said Friday and warned of a pairing up between the swine virus and that of birds' flu.A sixteen-year-old girl arrived at Assiut Airport from London with her family showed symptoms of the virus and was immediately taken to quarantine to receive treatment, Minister of Health's Assistant Dr. Nasr Al-Sayyid said.Egyptian authorities started a campaign to take poultry with bird's flu virus and inedible meat off the market.Local authorities cautioned of a possible pairing up between the swine and the bird flu viruses which will result in an epidemic.World Health Organization (WHO)that it is not possible to stop the outbreak of the swine flu virus as it became an epidemic afflicting 88,000 people 332 of whom died of the virus.For the first time in 40 years, WHO categorized H1N1 virus in June as an epidemic.

CHENNAI: The Indian Council of Medical Research will investigate what seems to be a case of “resistant” A (H1N1) virus in Chennai, its Director-General V. M. Katoch said. This is the first such case reported in the country.

The State health authorities have been asked to send a blood sample of the infected person to the National Institute of Virology (NIV), Pune.

The patient, a man who had flown in from the U.S. in the third week of June, had tested positive along with his wife.

They were quarantined at the Communicable Diseases Hospital (CDH) here and started on a course of Tamiflu. “This was through the Directly Observed Treatment Short-course method, which means we know he took every tablet and did not miss out on even a single dose. Missing on doses can lead to resistance, but that is not the case with this patient,” Director of Public Health S. Elango said.

While his wife recovered and tested negative for A (H1N1) after about 10 days, the husband continued to test positive even after the treatment was completed.

Though he showed no symptoms, his tests kept coming back positive, Dr. Elango said.

“This is a case to be studied, definitely. The virus should not remain in his blood after the treatment. It is possible that it is a mutation of the virus. I have instructed the officials at the NIV to sequence the strain [from the samples] as soon as possible. Once we have that, we can have the alternative drugs to treat the patient,” Dr. Katoch explained.

He said the patient at the CDH could be treated on recommended doses of the drug ‘Relenza’ available in India.

When told that the patient was anxious to go home, Dr. Katoch categorically said that he could not be discharged as long as he continued to test positive, even if he was not symptomatic.

“He is certainly a carrier and can spread the virus to members of his family, and thereby take it into the community. That should not be allowed to happen. Indigenous transmission of the virus from this person will lead to a huge public health problem,” Dr. Katoch said.

The issue would be sorted out as soon as the sequence was drawn up. “That way we will also be ready for any future occurrences.”